Chapter 7: Legal Dimensions of Nursing Practice
The client being admitted to the oncology unit conveys wishes regarding resuscitation in the event of cardiopulmonary arrest. The nurse advises the client that it would be in the client's best interest to obtain which document? A will A living will Proof of health care power of attorney A proxy directive
A living will Rationale:A living will is an advance directive that specifies the type of medical treatment clients do or do not want to receive should they be unable to speak for themselves in a terminal or otherwise unconscious condition. A will is a legal document detailing how to dispose of one's assets and belongings upon death. Proof of health care power of attorney and a proxy directive are documents identifying another person to legally make health care decisions for the client. In this case the client is stating the client's own decisions in advance of potential incapacitation.
Which scenario is an example of certification? A nurse who demonstrates advanced expertise in a content area of nursing through special testing A hospital that meets the standards of the Joint Commission An education program that meets the standards of the National League for Nursing A graduate of a nursing education program who passes the NCLEX-RN
A nurse who demonstrates advanced expertise in a content area of nursing through special testing Rationale: Certification is a voluntary process whereby a person who has met criteria established by a nongovernmental association is granted special recognition in a specified practice area. Licensure is granted by the state to a graduate of a nursing education program who passes the NCLEX-RN. Accreditation is a voluntary process by which a nursing education program is recognized as having met certain standards by the NLN Commission for Nursing Education Accreditation and/or the American Association of Colleges of Nursing. The Joint Commission can also accredit health care agencies.
An RN is working on a medical-surgical unit with a licensed practical/vocational nurse (LPN/LVN). Which action by the RN is considered negligent if injury results from this action? Asking the LPN/LVN to teach a new diabetic client how to administer insulin Calling the health care provider about abnormal lab results Obtaining vital signs on a newly admitted client Delegating oral medication administration to the LPN/LVN
Asking the LPN/LVN to teach a new diabetic client how to administer insulin Rationale: Negligence is harm that results because a person did not act reasonably. As nurses perform the role of delegators, they must know which tasks are legal and appropriate for particular health care providers to perform (scope of practice), as well as the policy for the facility at which they are employed. Teaching is not in the current scope of practice for a LPN/LVN, and thus the RN's delegation of this task to the LPN/LVN could be considered negligence. The other actions are within the scope of practice for a LPN/LVN.
A client admitted to a mental health unit has exhibited physical behaviors that put the client and others at risk. The nurse applies four-point restraints on the client without obtaining a physician's order or the client's consent. The nurse is at risk of being accused of which action? Slander Negligence Battery Malpractice
Battery Rationale: Battery is intentional and wrongful physical contact with a person that entails an injury or offensive touching. Performing treatment without permission or receiving informed consent from the client might constitute both assault and battery. Judgments of battery suits have been based on the application of restraints to confused clients. Slander is a verbal attack on a person's character. Malpractice pertains to actions committed and negligence to actions omitted that cause physical harm to a client.
An RN enters a client's room and observes the unlicensed assistive personnel (UAP) forcefully pushing a client down on the bed. The client starts crying and informs the UAP of the need to go to the bathroom. What action is the RN witnessing that should be immediately reported to the supervisor? Battery Assault Fraud Defamation of character
Battery Rationale: The UAP is engaging in battery, which is an assault that is carried out and includes willful, angry, and violent or negligent touching of another person's body or clothes or anything attached to (or held by) that other person. Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Defamation of character is an intentional tort in which one party makes derogatory remarks about another that harm the other party's reputation.
A nurse working in a coronary care unit resuscitates a client who had expressed wishes not to be resuscitated. Which tort has the nurse committed? Assault Battery Libel Slander
Battery Rationale:The nurse has committed battery by unlawfully carrying out a procedure that the client had refused. Battery is an assault and includes negligent touching of another person's body or clothes or anything attached to or held by that other person. Assault is the threat of touching another person without the person's consent. Defamation of character in spoken words is called slander. Libel is defamation of character in written words.
The nurse is providing care to a client who had orthopedic surgery. The nurse has medicated the client for pain. However, the client reports that the pain is unrelieved. The nurse takes no further action regarding assessment and intervention for the client's pain. The nurse does not notify the surgeon regarding the client's pain. The nurse's failure to take further action represents which element of liability in this case? Breach of duty Causation Damages Duty
Breach of duty Rationale: Breach of duty is the failure to assess, intervene, or notify the health care provider regarding the client's condition. It does not meet the expected standard of care. Duty refers to an obligation to use due care and is defined by the standard of care appropriate for the nurse-client relationship. Causation is when the failure to meet the standard of care caused injury. Damages are the harm or injury to the client.
A nurse is named as a defendant in a malpractice lawsuit. Which action would be recommended for this nurse? Discuss the case with the plaintiff to ensure understanding of each other's positions. If a mistake was made on a chart, change it to read appropriately. Be prepared to tell your side to the press, if necessary. Do not volunteer any information on the witness stand.
Do not volunteer any information on the witness stand. Rationale:The nurse on the witness stand should be polite, but not volunteer any information. The nurse should only answer the questions asked. The other answers are not examples of what a nurse should do in a malpractice lawsuit.
The nursing supervisor is preparing to delegate some aspects of the nursing care plan interventions to other healthcare providers on the unit. Which are the responsibilities of nursing supervisors? Select all that apply. Knowing the job descriptions and capabilities of each person on the team in depth Assigning tasks to staff according to each member's preference to improve staff moral Delegating the ultimate responsibility for the care provided to each staff member Assigning to registered nurses rather than nonprofessional staff the practice-pervasive functions of assessment Ensuring that care is delivered accurately and appropriately
Knowing the job descriptions and capabilities of each person on the team in depth Assigning to registered nurses rather than nonprofessional staff the practice-pervasive functions of assessment Ensuring that care is delivered accurately and appropriately Rationale: Nursing supervisors must know the job descriptions and capabilities of each person on the team in depth. Nursing supervisors should not assign tasks to staff according to each member's preference to improve staff moral but rather according to each member's capabilities and scope of practice. Nursing supervisors and other registered nurses may delegate specific aspects of care to nonprofessional staff but must select appropriate nursing care measures for these personnel to perform are held accountable ultimately for the care that is provided. Nursing supervisors and other registered nurses may not delegate the practice-pervasive functions of assessment, planning, diagnosis, evaluation, and nursing judgment to nonprofessional staff (NCSBN, 2005). Nursing supervisors and other registered nurses may delegate technical activities (i.e., feeding, ambulating) or provision of amenities (i.e., hospitality services, including making beds, setting up meals, cleaning the care environment), but the activities must not require critical thinking or professional judgment (American Nurses Association, 2005). Nursing supervisors also must ensure that nursing care measures have been carried out correctly.
A nurse is providing care to an older adult client. The client has been alert and independent with ambulation but now is exhibiting some confusion along with being unsteady when getting out of bed and walking. The nurse fails to report and document this change in status. No safety measures are taken and the client falls while getting out of bed to use the bathroom and fractures a hip. The client is experiencing significant pain from the fractured hip and requires surgery to repair the fracture. The nurse is sued for malpractice. Which action reflects the element of causation in this case? Responsibility to report changes in status Failure to document and report the change Lack of safety measures implemented with status change Fractured hip, pain, and need for surgery
Lack of safety measures implemented with status change Rationale: Causation is reflected by the nurse's failure to implement appropriate safety measures due to the change in the client's status. This failure causes the client to fall while attempting to get out of bed, resulting in a fractured hip. Duty is reflected by the responsibility of nurses to accurately assess clients, report changes in status, and implement measures to address changes in status. Breach of duty is reflected by (a) the failure to note and report that an older adult client previously assessed as alert and independent in ambulation is now exhibiting periods of confusion and unsteadiness when walking; and (b) by failure to execute and document use of appropriate safety measures (e.g., assisted ambulation). Damages are reflected in the result—that is, the fractured hip, pain, and need for surgery.
A nurse suspects that a client is a prostitute. The nurse documents this suspicion in the medical record and includes it in report to the oncoming shift. The nurse also mentions the suspicion to the nurse's sister saying, "I had a client named Susan in room 126 today who I think is a prostitute." Which violations has this nurse committed? Select all that apply. Libel Assault HIPAA Slander Battery
Libel HIPAA Slander Rationale: Slander is the spoken defamation of character (e.g., including in the change-of-shift report); libel is written defamation (e.g., including in the client record). HIPAA rules are violated when a client's personal information is disclosed (e.g., informing one's sister). The use of the client's room number and name make the client's presence in the facility discoverable. The nurse did not threaten the client (assault) or physically touch the client (battery).
What governing body has the authority to revoke or suspend a nurse's license? The State Board of Nurse Examiners The employing health care institution The National League for Nursing The Supreme Court
The State Board of Nurse Examiners Rationale: The State Board of Nurse Examiners in the United States may revoke or suspend a nurse's license or registration. The employing health care institution may have submitted the paperwork regarding the allegation of the issue but does not suspend or revoke the nurse's license. The National League for Nursing is a national organization for faculty nurses and leaders in nurse education. The Supreme Court is the highest judicial court in a country or state. The Supreme Court does not rule on a nurse's license.
A nurse is writing a letter to a U.S. congressman to support the promotion of health care issues. Which guidelines would ensure a properly written letter? Select all that apply. The nurse should state the purpose of the letter briefly and clearly in the first paragraph. The nurse should name the city and state where the nurse lives and votes. The nurse should avoid using specific examples from the workplace to support the position. The nurse should restate exactly what the legislator should do at the end of the letter. The nurse should write a longer email and shorter letter. The nurse should address the letter to as many legislators as possible.
The nurse should state the purpose of the letter briefly and clearly in the first paragraph. The nurse should name the city and state where the nurse lives and votes. The nurse should restate exactly what the legislator should do at the end of the letter. Rationale: Writing a letter to a U.S. congressman should be in the format of a formal letter, stating the nurse's concerns in a way that best relays this information. The formal letter should state the purpose of the letter briefly and clearly in the first paragraph, state the city and state where the nurse lives and votes, and restate exactly what the legislator should do at the end of the letter. The nurse should cite specific examples from the workplace to support the position. The letter should be kept to one page. The letter should be addressed to one legislator only, not a group of individuals.